Seeing is believing, or is it?

[Aaron]

Crystal

Thank you. I have looked in the past but could not get a understanding of the celephad extrusion. And the acid I was thinking of would be circulated through the vertabre itself to increase porosity not into the disc. I know some would go but it was just one of those things I saw done to something and thought of its application elsewere. Just curious.

And Keano, the more I read about the studies throughout the world they sound so good, but in reality it is a very complicated selection process is it not? Like ADR the selection process of elimination is one of the most important aspects of a successful outcome. And more and more these studies look to be tweaked for the doctors benefit. The idea itself is great but how could these doctors do an unbiased test? How would you disprove the results and verify they are not selecting the results they want to show. Are there any of these trials/studies that are done world wide at the same time and those results compared? This is an area I have not looked into as there are so few thorasic studies it would seem.

[Crystal33]

Aaron,
I didn't know what the term 'cephalad' meant though found it included in this site with good descriptions and MRI images of herniation types. It would be a dream to have an Fig.1 spine. Almost need sunglasses to view T2.
cme

[Keano16]

Originally Posted by Aaron

And Keano, the more I read about the studies throughout the world they sound so good, but in reality it is a very complicated selection process is it not? Like ADR the selection process of elimination is one of the most important aspects of a successful outcome. And more and more these studies look to be tweaked for the doctors benefit. The idea itself is great but how could these doctors do an unbiased test? How would you disprove the results and verify they are not selecting the results they want to show. Are there any of these trials/studies that are done world wide at the same time and those results compared? This is an area I have not looked into as there are so few thorasic studies it would seem.

Yes, unfortunately it is. But, some doctors for some reason expand indications. All researches and studies should be considered with caution of course. For example, for PLDD there are multi-center studies and they all prove the same: PLDD is safe and effective for contained herniations.

For thoracic studies, have a look at Wooridul Spine Hospital web site. I have seen a lot of scientific papers about T-spine.

[Crystal33]

Keano,
PLLD is not always safe unfortunately.
Salvage operation for persistent low back pain and... [Photomed Laser Surg. 2006] - PubMed result

It appears to compare well against microD and better for patient due to minimal invasive and outpatient procedure, and less risk of complications.
Comparison of results of 500 microdiscectomies and... [Photomed Laser Surg. 2006] - PubMed result

Don't know why it is not used more often. Maybe surgeon training, or open surgery is more profitable.

[Keano16]

Yes, you are right. I was speaking generally.

Key for success with PLDD is:
1. Proper patient selection
2. Surgeons technical skills and knowledge of the anatomy

Its not used more often because STILL most of spinal surgeons don't trust in minimally-invasive methods. Some of them tell me "I don't do minimally-invasive, it's new" ... Its not new! Its around us for 40 years already!

Some of them are scared because already mentioned anatomy problem. Not all bodies are the same, and every single percutaneous minimally-invasive method carries significant risks. Recently I attended a two level PLDD (L4-L5 and L5-S1). Doctor Saftic had big troubles reaching L5-S1 disc space, but in the end he succeed and patient is now completely pain fee (he had two level annular tear).

And third - Not all cases are for minimally-invasive approach. So, surgeons still do the gold standard micro-surgery.

[Aaron]

Yea, Keano I always think about knee surgury and how many were against the less invasive techniques in the begining and now that way is so accepted as the norm and so successful.

[mmglobal]

Crystal, I googled "hoogland abrasion" and was pleasantly surprised by the first result:

Dr. Hoogland's abrasion procedure. Restored disc height? - ISPINE.ORG Forum

I wrote this in 2006 and since then have gotten to spend several more days in the OR with Dr. Hoogland. There are several articles linked at the bottom of my post. I'd be happy to learn that I'm wrong, but as I understand it, the access to the disc for abrasion is endoscopic... the same as for his endoscopic discectomy. The idea of doing the abrasion on a disc that is not far enough down the degenerative cascade doesn't make much sense to me. I suppose it's possible, but I'll be surprised if its common. I don't know what the indications would be for abrasion that would not be considered a discectomy with abrasion. Remember that discectomies may not remove much disc material at all.

My wife had done in 2007. It was wildly successful for 3 months, then she started having leg pain on the other side and she had ADR a few months after that. I would not call this a failure of Hoogland's procedure. Diane's disc was far too severely compromised prior to the discectomy / abrasion. (Bertagnoli called this, but we did not listen to him and still started with the less invasive procedure.)

No surgery is always safe. Not every failure is attributable to surgical technique and/or improper diagnosis. We do less invasive surgeries hoping to salvage the discs and avoid more invasive surgeries. Most patients in the online communities who have had fusion or ADR and had prior, less invasive treatments would consider the earlier treatments a failure.

I wonder if I can dig up Diane's consent form for her 'abrasion' discectomy. I'll be surprised if it does not adequately disclose potential outcomes. I've gone through the consent process with clients for Hoogland, Zeegers and Bertagnoli. In each case, the surgeon walked us through the disclosure forms and discussed all possiblities. In some cases, we hear the parts that we want to hear and don't remember the rest.

Spine surgery sucks. Do your homework, make informed decisions.

Mark

[Crystal33]

Keano,
I would be interested to learn how PLLD helps annular tear issues. Does it seal the tears?

Mark,
I guess I view minimal invasive spine surgery (for discs) as needing to be minimal on two fronts:
1. minimal flesh wound not larger than endoscopic, and
2. minimal puncture of disc ie one that is likely to heal and not initiate new or accelerate degeneration.
If an endoscope is used but surgeon creates a box incision through annulus to remove some nucleus material, I would regard the surgery as major invasive as far as the disc is concerned, with increased chance of fusion or ADR required in future.

The Dr Hoogland ‘abrasion’ includes.... “a percutaneous transforaminal approach to the posterior segment of the involved disc was performed using special reamers up to 7.5 mm” 7.5mm sounds like a large opening needing to be permanently sealed somehow.
This is study outcome of 5mm animal puncture model…
Nerve fiber ingrowth into scar tissue formed follo... [Spine (Phila Pa 1976). 2006] - PubMed result

Even fine needle holes through annulus have been identified as posing a risk of initiating disc degeneration.

SMALL AND LARGE GAUGE NEEDLE PUNCTURE AFFECTS INTERVERTEBRAL DISC MECHANICS AND BIOLOGY IN AN ORGAN CULTURE MODEL -- Costi et al. 91-B (2): 351 -- The Journal of Bone and Joint Surgery (Proceedings)

2009 ISSLS Prize Winner: Does Discography Cause Accelerated... : Spine

Following paper is very interesting as it reports on short term disc outcomes where unintended discs were punctured by mistake during surgery.

Does Incorrect Level Needle Localization During Anterior Cer... : Spine

I think maybe the back surgery industry keeps silent on using supplements for disc regeneration (even if they work), and on the importance of maintaining annular integrity, because it depends on a steady, preferably increasing, flow of new patients thru the door. It is critical comment, that would be good to be disproved.